Coleman details recommendations

Institute of Medicine calls for universal health insurance

By Laurel Thomas Gnagey

Saying small steps toward providing health insurance for all Americans
are inadequate, President Mary Sue Coleman presented a report on behalf
of the Institute of Medicine (IOM) of the National Academies that called
upon Congress and the president to provide coverage for everyone in the
country by 2010.

“The committee believes this is an urgent problem—work must begin
immediately. There is no justifiable excuse for delay,” Coleman said
during a Jan. 14 public briefing in Washington, D.C. Her remarks were preceded
by comments from former Senate Majority Leader and presidential candidate Robert
Dole and former Democratic Rep. Paul Rogers of Florida.

In its sixth and final report on the status of the uninsured, the IOM
Committee on the Consequences of Uninsurance, which Coleman co-chairs,
gathered and analyzed evidence about the nation’s current and
historic approaches to health insurance. The committee’s intent
was not to offer specific strategies for providing health insurance
to the approximately 43 million Americans who currently are uninsured,
Coleman said. Its goal was to help policymakers and lawmakers by setting
forth the rationale and principles for universal coverage.

With the election year gearing up, Dole said many presidential candidates are
addressing the issue of the uninsured.

“It couldn’t come at a better time,” Dole said of the IOM call
for action. The former senator, who had his own experiences to relate about
trying to pass legislation for the uninsured, said the key is to get support
from Republicans and Democrats alike.
“Most legislation that lasts is bipartisan,” he said. “There
are people up there in both parties who think about this every day, who see
it with their constituents every day, who need a support group like this.

“[But] how do we get there, how do we pay for it and how do we make it
work?” Dole asked.

Rogers, who for eight of his 24 years in Congress served as chair of the House
Subcommittee on Health and the Environment, and who currently co-chairs the
National Coalition on Health Care, said it may not be well known, but support
is building for a national system of health care.

“Public opinion polls now are showing that up to 80 percent of Americans
are ready for fundamental health care reform that achieves universal coverage,” he
said. “The cause is attracting attention, and support is growing and
it will continue to grow.”

The final IOM report, “Insuring America’s Health: Principles and
Recommendations,” culminated three years of in-depth study of the effects
of lack of insurance on individuals, families, communities and the country,
Coleman said. Among other findings, the reports noted:

• 18,000 deaths a year can be attributed to a lack of health insurance
• Eighty percent of Americans who are uninsured have jobs or are part of families
in which someone works
•
Uninsured Americans get about half of the care those
with insurance receive, and they forego preventive care, such as blood pressure
and cancer screenings, and annual check-ups for their children, as well as
routine care of chronic conditions such as diabetes and heart disease
• Half of uninsured children visited a physician in 2001, compared with
three-quarters of insured children
• The United States loses the equivalent of $65 billion to $130 billion annually
as a result of poor health and early deaths of uninsured adults
• Tax dollars paid for an estimated 85 percent of the roughly $35 billion
in un-reimbursed medical care for uninsured people in 2001

Coleman’s co-chair on the committee, Dr. Arthur Kellerman, professor
and chair of the Department of Emergency Medicine at Emory University in
Atlanta, said the burden caused by un-reimbursed care creates financial hardship
for health care facilities, causing many to reduce beds, cut back on some
services or close entirely.

“They’ve had to take the airline approach to this problem,
which is to try to fill every seat,” Kellerman said. “That
doesn’t
work well when you have unscheduled admissions from the ER from a car
crash, a heart attack or a stroke. That is driving this problem.

“If we don’t have a system that works for everyone, it may not be
there for us and for our families, even with our health insurance, if the system
isn’t sufficiently supported to function the way it needs to function.”

In making its recommendations, the committee advanced what it called
five guiding principles to judge any proposed solutions to insuring
all Americans:

• Health care coverage should be universal
• Health care coverage should be continuous
• Health care coverage should be affordable to individuals and families
• The strategy for health insurance should be affordable and sustainable
for society
• Health insurance should enhance health and well-being by promoting
access to high-quality care that is effective, efficient, safe, timely,
patient-centered and equitable